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1.  Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial 
Background
Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease (COPD) to improve exercise capacity, symptoms and quality of life, however only a minority of individuals with COPD are able to participate. Travel and transport are frequently cited as barriers to uptake of centre-based programs. Other models of pulmonary rehabilitation, including home-based programs, have been proposed in order to improve access to this important treatment. Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life, but not all elements of the program were conducted in the home environment. It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity, symptoms and quality of life as a hospital-based program. The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD.
Methods/Design
This randomised, controlled, equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD. Participants will be randomly allocated to hospital-based or home-based pulmonary rehabilitation. Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks. Home-based programs will involve one home visit followed by seven weekly telephone calls, using a motivational interviewing approach to enhance exercise participation and facilitate self management. The primary outcome is change in 6-minute walk distance immediately following intervention. Measurements of exercise capacity, physical activity, symptoms and quality of life will be taken at baseline, immediately following the intervention and at 12 months, by a blinded assessor. Completion rates will be compared between programs. Direct healthcare costs and indirect (patient-related) costs will be measured to compare the cost-effectiveness of each program.
Discussion
This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner. The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD.
Trial registration
ClinicalTrials.gov: NCT01423227.
doi:10.1186/1471-2466-13-57
PMCID: PMC3844512  PMID: 24011178
2.  Home IV Antibiotic Therapy and Exercise Capacity in Children with CF: A Case Series 
Purpose: This case series describes the effect of home intravenous (IV) antibiotic therapy on spirometry and exercise capacity in a group of children with cystic fibrosis (CF). Methods: Outcomes from 10 children with CF who were prescribed a 14-day course of home IV antibiotics for a respiratory exacerbation are reported. All children performed spirometry and a modified shuttle test (MST) before and after 14-days of home IV therapy. Results: After 14 days, FEV1 increased by mean (± SE) 12 ± 4 % (p < 0.05) but mean MST did not improve compared to baseline. All children improved or maintained spirometry values with treatment, however, only 5 improved MST distance. Conclusion: After 14 days of home IV antibiotic therapy, a significant improvement in spirometry, but not exercise capacity, was seen in this small series of children with CF. The lack of improvement in exercise capacity for all children following home IV antibiotic therapy suggests factors other than spirometry determine exercise capacity. Identifying and investigating the factors that influence exercise capacity during home IV antibiotic therapy requires further investigation.
PMCID: PMC3056840  PMID: 21448344
cystic fibrosis; home IV therapy; FEV1; Modified Shuttle Test

Results 1-2 (2)